is a staff CRNA at Duke University Medical Center, Duke Medicine, Durham, North Carolina. Email:
is a staff CRNA at Duke University Medical Center and Assistant Professor at Duke University School of Nursing, Duke University, Durham, North Carolina.
AANA J. 2024 Apr;92(2):139-143.
Administration of succinylcholine to patients with a variant in the butyrylcholinesterase (BChE) gene increases the risk of anesthesia emergence prior to recovery from neuromuscular blockade (NMB). Application of quantitative neuromuscular monitoring (NMM) can identify residual NMB. We present two patients with abnormal BChE gene variants. In the first case, quantitative monitoring was applied too late to prevent awareness, but allowed diagnosis and prevented admission to the intensive care unit. In the second case, monitoring was applied prior to NMB, which enabled early diagnosis and prevented premature awakening from anesthesia. These cases illustrate the importance of quantitative NMM, even in short cases and with short-acting depolarizing agents such as succinylcholine. The clinical implications of this report include a more consistent use of NMM to identify and manage patients with undiagnosed abnormal BChE and to prevent premature anesthesia emergence.
给携带丁酰胆碱酯酶（BChE）基因突变的患者使用琥珀酰胆碱会增加麻醉苏醒前神经肌肉阻滞（NMB）恢复的风险。应用定量神经肌肉监测（NMM）可以识别残余的 NMB。我们介绍了两例 BChE 基因突变异常的患者。在第一个病例中，定量监测应用得太晚，无法预防意识发生，但可以进行诊断并防止入住重症监护病房。在第二个病例中，在使用琥珀酰胆碱前进行了监测，这使得可以早期诊断并防止从麻醉中过早苏醒。这些病例说明了定量 NMM 的重要性，即使在短时间手术和使用短效去极化剂如琥珀酰胆碱的情况下也是如此。本报告的临床意义包括更一致地使用 NMM 来识别和管理未确诊的异常 BChE 患者，并预防过早的麻醉苏醒。
